One in five of those with a confirmed diagnosis experienced shocks from their ICDs during follow-up for an average of 9.3 years (2.2 events per 100 person-years), according to a group led by Jaime Hernandez-Ojeda, MD, PhD, of Hospital Clínic de Barcelona, in the October 17 issue of the Journal of the American College of Cardiology.

"ICD therapy is an effective therapy in high-risk patients with Brugada syndrome," they concluded. "However, it is also associated with a significant risk of device-related complications. Special care during ICD implantation, adequate device programming, and regular follow-up may allow reducing the number of adverse events."

The risk of ICD-related adverse events was 23% (2.5 per 100 person-years), which included an 8.7% rate of inappropriate shocks (0.9 per 100 person-years) and a 20.2% incidence of other ICD-related complications (1.4 per 100 person-years). In all, 2.9% with Brugada syndrome died after ICD placement.

Of note was Hernandez-Ojeda and colleagues' suggestion that "the most remarkable finding of this prospective single-center cohort, was the considerably lower rate of shocks due to rapid atrial rhythms (including sinus tachycardia, atrial fibrillation, and other supraventricular arrhythmias) compared with other prior studies despite the longer follow-up (life-time risk of 2.9%, incidence rate of 0.3 per 100 person-years)."

Of 370 Brugada syndrome patients (mean age 43 years, 74% men) who were diagnosed between 1994 and 2015 at a single center, the 104 who got ICDs were included in the analysis (28.1%). Their average age at implantation was 46.2, and most were for primary prevention (90.4%).

It took an average 48.8 months from ICD implantation to first shock overall. Appropriate shocks more commonly came from ICDs for secondary prevention (P<0.01).

The study was limited by inclusion only of people with a Brugada diagnosis, the heterogeneity in ICD indications in the study population, and a low number of events.

Even so, "one of the most important clinical points of this study is that at a high-volume referral center for Brugada syndrome, for all registry patients enrolled from 1994 to 2015, only 28% received an ICD," commented Fred Kusumoto, MD, of the Mayo Clinic in Jacksonville, Florida, and Chris Austin, MD, of University of Florida, Gainesville, in an accompanying editorial.

Kusumoto and Austin noted that the study is part of increased efforts to study Brugada syndrome: in the 1998-2002 period, there were fewer than 400 scientific articles about Brugada, compared with more than 1,400 in 2013-2017.

Their take-away from the trend: "The evolution of our understanding of Brugada syndrome emphasizes the importance of continued professional development and the difficulties with staying abreast in an exponentially expanding evidence base environment."

"Dissemination of new medical information has traditionally occurred through journal articles and large annual scientific conferences, but given the sheer scope of information available, the most clinically relevant data are now often accessed through professional society guidelines. It is critical that these documents also evolve from comprehensive reviews or 'book chapters' to user-directed 'vehicles' or 'packages' that provide practical clinical advice, account for the nuances of individual care, and are completely transparent with freedom from apparent bias."

Relevant information and recommendations should be immediately available to the physician-patient team, they suggested.

Hernandez-Ojeda, Kusumoto, and Austin reported no conflicts of interest.

Reviewed by Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner

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